EXAM 3 - Neurodevelopmental Disorders

Question 1

Diagnosed first

Answer 1

in infancy, childhood, or adolescence

Question 2

Neurodevelopmental Disorders Include the following:

Answer 2

Attention deficit hyperactivity disorder 
Specific learning disorder
Autism spectrum disorder
Intellectual Disability
Communication and Motor Disorders

Question 3

Scope of learning disorders

Answer 3

Academic problems in reading, mathematics, and/or writing
Performance is substantially below expected levels based on age and/or demonstrated capacity
Problems persist for 6+ months despite targeted intervention

Question 4

impairment in reading

Answer 4

Dyslexia

Question 5

Dyslexia may include

Answer 5

Word Reading Accuracy
Decoding (Phonological Awareness)
The most common form of “dyslexia”
Reading fluency (rate)
Reading comprehension
It is not reversing the order of letters!

Question 6

impairment in written expression

Answer 6

dysgraphia

Question 7

dysgraphia may include

Answer 7

Graphomotor
Spelling accuracy
Grammar punctuation and accuracy
Clarity/organization of written expression

Question 8

impairment in mathematics

Answer 8

Dyscalculia

Question 9

Dyscalculia may include

Answer 9

Number sense
Memorization of arithmetic facts
Accurate or fluent calculation
Accurate math reasoning

Question 10

Prevalence of learning disorders

Answer 10

6.5 million children have been diagnosed in the United States
Highest rate of diagnosis in wealthier regions, but children with low SES more likely to have difficulties
Reading difficulties most common, affect 4-10% of the general population

Question 11

Students with learning disorders are more likely to

Answer 11

Drop out of school
Be unemployed
Have suicidal thoughts
Have negative school experiences
May be related to communication disorders

Question 12

Causes of Specific Learning Disorder

Genetic and neurobiological contributions

Answer 12

Learning disorders run in families
Evidence for subtle neurological difficulties is mounting (e.g., decreased functioning of areas responsible for word recognition)
Overall, contributions are unclea

Question 13

Causes of Specific Learning DisorderPsychosocial contributions are likely important

Answer 13

Some languages more difficult to read > higher rates of reading impairment
Motivational factors
Socioeconomic status
Cultural expectations
Parental interactions
Child management practices

Question 14

Treatment of Specific Learning Disorder

Answer 14

Requires intense educational interventions
Data support behavioral educational interventions
Biological interventions (e.g., Ritalin) usually used only for those individuals who also have ADHD

Question 15

Autism Spectrum Disorder

Answer 15

In DSM-5, it is categorized as a Neurodevelopmental Disorder
Problems occur in language, socialization, and cognition
Pervasive – problems span many life areas
Two main areas of impairment:
Communication and social interaction
25% don’t acquire effective speech
Restricted, repetitive patterns of behavior, interests, or activities

Question 16

Autism Spectrum Disorder

Answer 16

Label is new to DSM-5
Encompasses several disorders previously classified as “pervasive developmental disorders”
Including:
Autistic disorder 
Asperger’s disorder
Childhood disintegrative disorder
Rett syndrome

Question 17

Autism Spectrum Disorder-Three levels of severity

Answer 17

Level 1— “Requiring support”
Level 2— “Requiring substantial support”
Level 3— “Requiring very substantial support”
Described qualitatively and, as yet, has no quantitative equivalent
With and Without Intellectual Impairment
Catatonia is an additional qualifier

Question 18

DSM5 Autism Spectrum Disorder

Diagnostic Criteria

Answer 18

A. Persistent deficits in social communication and social interaction across multiple contexts, as manifested by the following, currently or by history (examples are illustrative, not exhaustive, see text):

1. Deficits in social-emotional reciprocity, ranging, for example, from abnormal social approach and failure of normal back-and-forth conversation; to reduced sharing of interests, emotions, or affect; to failure to initiate or respond to social interactions.
2. Deficits in nonverbal communicative behaviors used for social interaction, ranging, for example, from poorly integrated verbal and nonverbal communication; to abnormalities in eye contact and body language or deficits in understanding and use of gestures; to a total lack of facial expressions and nonverbal communication.
3. Deficits in developing, maintaining, and understanding relationships, ranging, for example, from difficulties adjusting behavior to suit various social contexts; to difficulties in sharing imaginative play or in making friends; to absence of interest in peers.

Specify current severity: Severity is based on social communication impairments and restricted repetitive patterns of behavior. (See table below.)

B. Restricted, repetitive patterns of behavior, interests, or activities, as manifested by at least two of the following, currently or by history (examples are illustrative, not exhaustive; see text):

1. Stereotyped or repetitive motor movements, use of objects, or speech (e.g., simple motor stereotypes, lining up toys or flipping objects, echolalia, idiosyncratic phrases).
2. Insistence on sameness, inflexible adherence to routines, or ritualized patterns or verbal nonverbal behavior (e.g., extreme distress at small changes, difficulties with transitions, rigid thinking patterns, greeting rituals, need to take same route or eat food every day).
3. Highly restricted, fixated interests that are abnormal in intensity or focus (e.g, strong attachment to or preoccupation with unusual objects, excessively circumscribed or perseverative interest).
4. Hyper- or hyporeactivity to sensory input or unusual interests in sensory aspects of the environment (e.g., apparent indifference to pain/temperature, adverse response to specific sounds or textures, excessive smelling or touching of objects, visual fascination with lights or movement).

Specify current severity: Severity is based on social communication impairments and restricted, repetitive patterns of behavior. (See table below.)

C. Symptoms must be present in the early developmental period (but may not become fully manifest until social demands exceed limited capacities or may be masked by learned strategies in later life).

D. Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning.

E. These disturbances are not better explained by intellectual disability (intellectual developmental disorder) or global developmental delay. Intellectual disability and autism spectrum disorder frequently co-occur; to make comorbid diagnoses of autism spectrum disorder and intellectual disability, social communication should be below that expected for general developmental level.

Question 19

Impairment in Social Communication and Interaction

Answer 19

Failure to develop age-appropriate social relationships
Trouble initiating and maintaining relationships
Trouble with nonverbal communication
May lack appropriate expressions, tone
Trouble with social reciprocity
Deficits in joint attention – the ability to communicate interest in an external stimulus and another person at the same time

Question 20

Severe forms:Stereotyped or ritualistic behavior

Answer 20

E.g., spinning, waving hands, rocking

Question 21

Less severe forms: Intense, circumscribed interest in very specific subjects

Answer 21

Having restricted areas of interest may compound difficulties relating to others

Question 22

Autism Spectrum Disorder: Prevalence

Answer 22

Previously thought to be very rare, but this is not the case
1 in 50 school-aged children meet criteria
More commonly diagnosed in males
Gender ratio: 4-5:1
IQ interaction
38% show intellectual disabilities
Occurs worldwide

Question 23

Psychological and Social Dimensions of Autism - Historical views

Answer 23

Failed parenting
Perfectionistic, cold, and aloof
Parents thought to have high socioeconomic status and higher Iqs
This view is not true
Originally thought to be lack of self-awareness
Later, many individuals with ASD shown to have intact awareness of self

Question 24

Biological Dimensions/Etiology of Autism

Answer 24

March 2002, NIMH began a 5 year, $6 million grant to identify genetic markers
The Autism Genetic Resource Exchange (AGRE) gene bank is collecting information
This is a brain disorder that children are born with
Concordance rates vary from 60 to 95% for MZ twins (If autism isn’t present, learning disabilities in language or a social disorder are present)

Question 25

Biological Dimensions - Significant genetic component

Answer 25

Familial component: If you have one child with autism, the chance of having a second child with autism is 20% (100x greater risk than general population)
Numerous genes on several chromosomes involved
Oxytocin receptor genes
Bonding and social memory
Older parents associated with increased risk

Question 26

Biological Dimensions of Autism - Neurobiological influences

Answer 26

Amygdala
Larger size at birth = higher anxiety, fear
Elevated cortisol
Neuronal damage in the amygdala results from high stress, which may affect processing of social situations
Oxytocin
Lower levels in individuals with ASD
Limbic System and Cerebellum (too many cells and smaller in the limbic system)
May be that brain growth is unusually rapid at age 2 or 3 and then arrested
This would results in cerebral and cerebellar brain volume being smaller at older ages
Prenatal illness may predispose child

Question 27

Biological Dimensions - Neurobiological influences

Answer 27

Vaccinations do NOT increase the risk of autism
Mercury and preservatives in some vaccinations was rumored to increase autism risk
Large scale studies do NOT support this
High rates of vaccinations do NOT increase risk for autism in the community at large
Health risk of not vaccinating is substantial

Question 28

Treatment of Autism Spectrum Disorder - Psychosocial treatments

Answer 28

Behavioral approaches
Skill building
Reduce problem behaviors (“ABA”)
Communication and language training
Increase socialization
Emotion identification and recognition
Early intervention is critical

Question 29

Treatment of Autism Spectrum Disorder - Biological treatments

Answer 29

Medical intervention has had little positive impact on core dysfunction
Some drugs decrease agitation 
Tranquilizers 
SSRIs
Indicators of good prognosis
High IQ, good language ability

Question 30

Treatment of Autism Spectrum Disorder - Integrated treatments

Answer 30

Preferred model: Multidimensional, comprehensive focus
Children offered special education at school focusing on communication
Judicious use of medication in some cases
Families given support too
When older, focus on integrating into the community while maximizing independence

Question 31

Comprehensive Treatment Programs for ASD

Answer 31

Behavior Modification is used to teach a variety of skills along with speech therapy and occupational and physical therapy
TEACCH (U. of N. Carolina) focuses on developing the child’s communication (doesn’t necessarily have to be verbal) and social interaction skills.
Lovaas’s approach (UCLA) focuses on using intensive operant conditioning (often criticized for use of aversives although it’s not necessary to use these)

Question 32

Intellectual Disability (Intellectual Development Disorder)

Answer 32

Impaired Intellectual Functioning
Impaired Adaptive Functioning
Must have both impairments for ID
Standard scores on both assessments at or below 70 (Remember average functioning ranges from about 90 to 109)
Was previously an Axis II diagnosis in the DSM

Question 33

Intellectual Disability: Statistics

Answer 33

Prevalence = 2% of general population
9 in 10 people with ID have mild impairment (IQ 50-70)
Chronic course
Highly variable individual prognosis
Independence is possible for many individuals with mild impairment when provided with appropriate resources (e.g., skills training)

Question 34

DSM-5 identifies difficulties in three domains of Intellectual Disability

Answer 34

Conceptual (e.g., skill deficits in areas such as language, reasoning, knowledge, and memory)
Social (e.g., problems with social judgment and the ability to make and retain friendships)
Practical (e.g., difficulties managing personal care or job responsibilities)

Question 35

DSM5 Diagnostic criteria for intellectual disability

Answer 35

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